Academics call for NPfIT technical assessment

Tags: Confidentiality DH Government House of Commons Informatics Information Information Commissioner iS NPfIT Office Safety

11 Apr 2006

A group of 23 computer science academics from around the UK have written an open letter calling for an “independent technical assessment” of the National Programme for IT.

They say in their letter to the House of Commons health select committee: "Concrete, objective information about NPfIT's [National Programme for IT] progress is not available to external observers. Reliable sources within NPfIT have raised concerns about the technology itself.

"The National Audit Office report about NPfIT is delayed until this summer, at the earliest; the report is not expected to address major technical issues. As computer scientists, engineers and informaticians, we question the wisdom of continuing NPfIT without an independent assessment of its basic technical viability."

A department of health (DH) spokesperson said: “The national programme is under constant review, scrutiny and audit by parliament and government bodies. It is a robust and resilient programme of healthcare IT delivery in the NHS.

“We remain confident that the technical architecture of the national programme is appropriate and will enable benefits to be delivered for patients, whilst ensuring value for money to the taxpayer.”

There was no direct comment from Connecting for Health, the DH agency running the national programme.

The letter, reported today in Computer Weekly, was sent to the select committee by Martyn Thomas, visiting professor of software engineering at Oxford University and expert witness in legal cases involving complex software engineering issues.

Other signatories include: Professor Ewart Carson of the Centre for Health Informatics, City University; Professor Ross Anderson of Cambridge University; Professor Ray Ison of the Open University and Professor Michael Smith, a former professor of informatics at Keele University and director of information for North Staffordshire Health Authority.

They suggest an assessment should ask:

Does the NPfIT have a robust, comprehensive technical architecture, project plan and detailed design? Have these documents been reviewed by experts of calibre appropriate to the scope of NPfIT?

Are the architecture and components of NPfIT likely to meet:

• The current and future needs of stakeholders?

• Support the need for continuous 24/7 healthcare IT support and fully address patient safety and organisational continuity issues?

• Conform to guidance from the information commissioner in respect to patient confidentiality and the Data Protection Act?

Has a realistic assessment been carried out about the:

• Volumes of data and traffic that a fully functioning NPfIT will have to support across thousands of healthcare organisations in England?

• Need for responsiveness, reliability, resilience and recovery under routine and full system load?

They add that an independent review would cost a tiny proportion of the proposed £6 billion spend on the national programme and could save many times its cost.

Liberal Democrat health spokesman, Steve Webb, said: “They are absolutely right to call for the health select committee to investigate the NHS IT programme. Parliamentary scrutiny of this massive programme is almost non-existent as the government hides behind the excuse of commercial confidentiality.

“We urgently need to know what is happening with this project - both for the sake of the taxpayer and the health service.”

Readers Comments

A welcome move

11 Apr 06 11:15

This move - calling for more objectivity about CfH - seems like an important step. EHI readers may be interested in visiting this link where they can add their support to the call for an independent audit.

http://snipurl.com/p19t

Job losses at CSC

11 Apr 06 16:19

At least a delayed NAO Report will be able to consider the impact on NPfIT of the recently-announced proposed job cuts within CSC, the NWWM LSP. Perhaps CSC is trying to avoid the income and profits warnings which some other LSPs have declared recently as a result of NPfIT/CfH delays?

Interesting timings

11 Apr 06 16:32

Flattering as it is that our colleagues in the academic sector are taking an interest in our work, I'm mystified by the timing of this letter and what specifically has precipitated it. There's nothing new here, and frankly, they might have raised these issues any time in the last four years. Why now?

When is a good time ?

11 Apr 06 17:46

I applaud the academics for their interest. Perhaps if the whole project had been less secretive and the results of the National Audit Office had been published there would be have been less of an need for this approach. If you take a step back and look, this appears more and more like a project that is failing to deliver what was promised, with lots of hopeful statements that mask the truth. I do wonder if we getting to the point of “the wheel is spinning but the hamster is dead”, and our academic friends have decided this is a good time to expose this.

A suggestion on timing ...

11 Apr 06 18:12

Perhaps the academics wanted to give the Programme the benefit of the doubt? But as there has been so little tangible progress over the last three-and-a-half years, maybe they now feel the "point of no return" has been reached. And - frankly - it has been rather difficult for anyone to take a meaningful interest in CfH's work, which has been characterised by an unhelpful veil of secrecy. Fortunately, the growing series of missed deadlines and technical problems has proved hard to conceal and has rather given the game away.

Also, it's not just academics expressing concern: clinicians, managers, politicians, IT consultants, media specialists and others have all recently questioned whether CfH should be reviewed.

So let's hope our academic colleagues' intervention creates the critical mass of protest that provokes some remedial action!

Assessment criteria

tim.craig@inmezzo.com

11 Apr 06 20:20

There are at least two key criteria missing from the academics letter to the select committee: 1. Does the architecture recognise the requirements to share information with other agencies? In particular with Local Authorities in the CSIP programme? 2. How does the architecture incorporate the growing use of mobile technologies in health service provision?

Regards

Tim Craig

SNOMED CT fit for EMR?

roger@safescript.org

11 Apr 06 21:34

I recently attended a conference on Implementing SNOMED CT a core part of CfH. It is quite clear that most attendees believed at the end of the day that SNOMED CT is not fit for purpose i.e. coding the EMR where do we go now>? Back to the drawing board

Why now?

jlgh_consult@dsl.pipex.com

11 Apr 06 23:29

Why now?

Just limiting ourselves to stories on this site only just since end of December....

Spine down http://www.e-health-insider.com/news/item.cfm?ID=1619

C & B down http://www.e-health-insider.com/news/item.cfm?ID=1624

Errors in iSoft iPM http://www.e-health-insider.com/news/item.cfm?ID=1632

Medix survey http://www.e-health-insider.com/news/item.cfm?ID=1634

NWWM PACS uncertainty http://www.e-health-insider.com/news/item.cfm?ID=1649

iSoft delays http://www.e-health-insider.com/news/item.cfm?ID=1670

Plymouth interim PAS http://www.e-health-insider.com/news/item.cfm?ID=1674

Interim Mental Health System http://www.e-health-insider.com/news/item.cfm?ID=1704

Delays to XML http://www.e-health-insider.com/news/item.cfm?ID=1709

Child Health migration loses critical data http://www.e-health-insider.com/news/item.cfm?ID=1729

NWWM PACS delay http://www.e-health-insider.com/news/item.cfm?ID=1744

South slips http://www.e-health-insider.com/news/item.cfm?ID=1763

Unworkable Smartcard policies http://www.e-health-insider.com/news/item.cfm?ID=1764

NAO report will be critical http://www.e-health-insider.com/news/item.cfm?ID=1779

Accenture losses from NPfIT delay http://www.e-health-insider.com/news/item.cfm?ID=1795

Technical evaluation of standards

12 Apr 06 10:02

Roger's SNOMED CT comment exemplifies a fundamental problem with CfH's approach: that of overlooking rigorous evaluation of technical and other standards before rushing ahead and attempting to implement them widely. SNOMED CT, dm+d, HL7 v3: the ISB website suggests that none of these are approved NHS standards in any meaningful sense, though they are actively being incorporated into CfH systems. There seems to be a failure to learn from the past here: has anyone explained how SNOMED CT has addressed the technical and other problems with clinical codes highlighted in the PAC's enquiry into the Read Codes almost 10 years ago?

http://www.publications.parliament.uk/pa/cm199798/cmselect/cmpubacc/657/65707.htm

In my opinion, assessment of the standards (and how they interoperate) would, of itself, be adequate justification for a detailed technical review of CfH. Meanwhile - on the basis of "better the devil you know" - perhaps the NHS should stick with what it's got already (i.e. Read Codes etc).

And from

12 Apr 06 10:07

the days they used to have the forums on this website you can be pretty certains that all of this was predicited from the very beginning. Maybe E-health can had them over if they have back ups to the commitee as evidance.

Im sure Computer Weekly will happily provide old copies of their jornal going back a number of years.

Not the time to lose nerve

12 Apr 06 14:27

An independent assessment might be a good idea in parallel with the current programme but I for one would not like this to stall the project never to start again because it gives the opportunity to take a political decision to retreat.

Also I suspect Accenture and iSoft are in a very intense review of what they need to do given the risks they are holding, given the contracts they signed. BT were I believe in a similar position to them early on with the N3 contract - one aspect of CfH that is ahead of schedule now.

Yes I can hear the cries that it is stalled already but as an addict of the "How are we doing?" and "12 week implementation forecast" (at end of "Implementation") sections of the NHS Connecting for Health website there are definitely some encouraging signs:

60,000 prescriptions transmitted electronically per week and growing fast (doubled since January)

3 million new images stored using PACS per week and again growing fast (more than doubled since January)

23,000 Choose and Book bookings per week (increasing but more of a slow burn)

Having worked in NHS IT for many years just prior to the starting of CfH, I can imagine the frustration of the planning blight caused by the delay in the Trust systems. However given that achieving EPR was the strategic plan in the 1980's, then 1990's and again in Information for Health at the turn of the Century, it would really be a shame to see the NHS connecting for Health opportunity lost to achieve this in a joined up way, given the very patchy progress beforehand.

Also if you look at the Southern Cluster who were the last LSP contract to be signed, then had IDX replaced by Cerner, they are apparently really making progress now on the basis of the 12 week forecasts. Also the South is halfway through rolling out PACS everywhere and that wasn't even in the original NPfIT plan.

Not everything is rosey in the Connecting for Health garden for sure but lets not talk it down so much that it gets planning permission for a block of flats or an independent treatment centre.

Oh yes, time to loose nerve

12 Apr 06 19:18

Wow, involved since just before NPfIT. Not so long my friend.

The problem with CfH/NPfIT and all the previous initiatives has been lack of funding at the coalface. Frank Burns and Derek Wanless succeeded in getting serious money for IM&T modernisation, and the CfH gang have burned it.

N3 is not ahead when you look at all the shortcuts and reworking required, and the silence from NOC is deafening.

Perhaps the addict of the CfH propaganda would care to ask what is really happening on the ground ?

ABOUT TIME!

cmaj1966@yahoo.co.uk

12 Apr 06 22:50

It is about time someone investigated this spending of 6.2 billion pounds on IT when the NHS is in a critical state and staff are losing their jobs. This money could have been better spent perhaps on the lady who won her case today - cancer drugs.

Myths and misspending

13 Apr 06 10:16

Yes, funding at the coalface has always been poor - but I don't agree that CFH / NPfIT is responsible. Frank Burns got serious money committed, only to see local organisations spend it elsewhere. The About Time! posting above is part of the reason - that in a world of competing priorities, IT often loses out to some other local imperative. That was part of the rationale for CFH in the first place. The unfortunate side effect is that it also gives local organisations even more of an excuse not to fund IT locally.

As for the academics, is it only me that wonders whether their idea of an 'independent technical assessment' would involve a lucrative contract going to a some experts from the university sector?

They haven't spent £6.2bn

13 Apr 06 10:45

Isn't the point though that CfH haven't spent the £6.2bn yet and won't until the contractors deliver - hence the pain being felt by Accenture and iSoft. Frank Burns did do a great job getting money for IT - which was then devolved locally and spent on waiting list initiatives in many places. It is always difficult to make the case for IT spending when it is put alongside immediate clinical priorities but we the public do also now expect the service to be seamless and information appropriately shared. The huge amount of duplicate data collection and hunting round for bits of paper in the NHS is the scandal.

Until or Unless?

13 Apr 06 11:43

The last comment makes the valid point that the £6.2 bn will not be spent UNTIL the contractors deliver. But, surely, a major point of the review is to confirm that delivery as planned is technically feasible: otherwise the NHS may wait indefinitely for something that can never materialise.

Good point

13 Apr 06 12:13

Yes fair point Until or Unless? I see from the CfH website that Richard Granger has invited the academics to a meeting so it will be interesting to see what they say after that.

Interesting response from CfH

13 Apr 06 13:43

The 2 hours that Richard Granger has set aside for this meeting (according to the letter on the CfH website) seems hardly likely to offer an adequate opportunity to explain the recurring problems with his complex NHS IT programme. It is helpful, however, that he has copied the letter to the academics' heads of department: this will give them the opportunity to considering adding their support to their colleagues' calls for an enquiry, and to ensure that their academic freedom is maintained.

According to the web page, the Programme is "modern, robust and designed to be future proof": nothing at all to fear from the proposed review then!

A cunning plan

roger@safescript.org

14 Apr 06 12:17

Just in case Granger wants to ivite me to his meeting I have an outline plan which can deal with most of the problems in a simple inexpensive way. Summary:

- GP systems (the only working EMRs in place) should be developed as the NHS 'boss' EMRs - Read version 2 should be reworked (my feasibility study shows this is possible) to replace SNOMED add in needed terms from Read 3 and even SNOMED CT if there are any - DM&D should be abandoned and Read 2 retained for ETP - Secondary care EMR should be derived from GP EMR - Secondary care EMR should be populated by dissemination of selected GP EMR content - The 'Spine' should be a conduit for EMR content - not store medical records, except demographics. - Communication of all EMR medical information starts at and is returned to the 'boss' GP EMR - An independent (of government) organization should collect anonymised EMR data for medical research and pharmaco-epidemiology.I propose DIN (Doctors' Independent Network) why not?

Roger Weeks GP, Md SafeScript, Chair DIN

Very expensive PAS

16 Apr 06 18:32

The point surely is about what is being delivered, whether it is Value for Money, and will capable to become the one clinical record, replacing paper. When it appears that LSPs are struggling 3-4 years in to provide a basic PAS suited to UK practice, one has to wonder. I will be suprised if by year 7 most hospitals have a functioning basic system. And we will be into re-procurement.

And so many features seem to have been overlooked by these excellent contracts, where they have somehow become optional extras to be funded locally.

I fear less the academics, who may perhaps be trying to make a small sum from a consultancy review. I am more concerned at the size of the gap between what has been bought, and what it would truly take to deliver the original vision. And the price tag that LSPs would like to extract to deliver it.

And then to be flexible enough to respond to the continually changing new requirements placed upon us. That was ever the challenge.